This week we celebrate the 25th anniversary of the Harare Declaration, and in the editorial Bruno Meessen reflects on what this quarter of a century has brought about. We feature an important piece from the Lancet which links maternal obesity to neonatal mortality. An significant “event of the week” was Hillary Clinton’s visit to Africa, one of the most controversial parts of which was the speech she gave on aid.
Enjoy your reading,
Kristof Decoster, David Hercot, Ildikó Bokros, Basile Keugoung & Wim Van Damme
Looking back on the Harare Declaration and the Bamako Initiative
by Bruno Meessen (on behalf of the Harmonization for Health in Africa communities of practice)
25 years ago, between the 3rd and the 7th of August 1987, the WHO organized an interregional meeting in Harare. The meeting, which was about the implementation of primary health care (following up of the Alma Ata conference in1978), ended with a statement that is known (or forgotten!) today as the Harare Declaration. By establishing the health district model as a reference strategy to organize and develop health services, this event shaped health systems in many poor countries. This strategy particularly shaped health service provision in rural Africa.
Read the rest of the editorial here
Global Health Policy and Financing
1. Lancet – Maternal obesity and neonatal mortality in sub-Saharan Africa
New research indicates that babies born to overweight or obese mothers in sub-Saharan Africa (where an estimated 17.5% of adults could be obese by 2030) are more likely to die in the first two days after birth. The analysis is based on data from The Demographic and Health Surveys from 27 countries in sub-Saharan Africa, and is the first to shed light on the link between maternal obesity and neonatal mortality in developing countries. The research is assessed further in a Comment and an accompanying podcast.
2. Lancet – New global estimates of malaria deaths
Today the Lancet publishes a number of reactions to Murray’s article on global estimates of malaria deaths published in February this year. They suggest that Murray has used data the reliability of which is highyl questionable. Adult mortality is especially criticized for being overestimated when relying on verbal autopsy
3. WHO | Performance-based financing in low- and middle-income countries: still more questions than answers
Atle Fretheim, Sophie Witter, Anne Karin Lindahl & Ingvar Theo Olsen;
Fretheim and colleagues did a Cochrane review of Performance Based Financing in the health sector. They found that the evidence of impact was limited and at times contradictory. They highlight that these kind of interventions are highly context sensitive. They also argue that RCT designs are difficult to implement for complex interventions in real life settings. Still, efforts should be encouraged to produce unbiased evaluations of the PBF experiences in health.
4. Prevention of AIDS among sex workers in Indonesia faces opposition from religious groups
25 out 250 sex workers are estimated to be infected with HIV in Indonesia. The AIDS epidemic here is among the fastest-growing in Asia, and new infections have tripled in the last six years. Alarmingly, risky sexual behavior has taken over from intravenous drug use as the main route for its spread. If this wasn’t problematic enough, the country is now experiencing a moral battle over condoms led by Islamic pressure groups arguing that they encourage promiscuity. A recent campaign promoting safe sex has been denounced “obscene” by the Islamic Defenders Front or FPI (the same group that led protests forcing Lady Gaga to cancel her Jakarta concerts) and the former head of the National Aids Commission (who initiated the campaign) faced a protest organized by the radical Islamist movement Hizbut Tahrir.
5. Hillary travels to Africa
Hillary Clinton discussed global AIDS efforts during her 11-day African tour. In South Africa she spoke with Foreign Minister Maite Nkoana-Mashabane “in the second cabinet-level strategic dialogue between the two nations,” and said “that global efforts to stop the virus ‘have saved hundreds of thousands of lives.” (AP)
According to many, Hillary isn’t the right person to speak about untied aid. Her speech received wide media coverage and was termed “morally superior” and “deluded.” The Chinese media was also among the first to react by saying that Hillary’s statements were part of a hidden agenda “aimed at least partly at discrediting China’s engagement with the continent and curbing China’s influence there.”
6. A report on in-kind donation
The articles discusses a report on the effectiveness of in-kind donation. One of the major problems is the allocation and lack of resources that can extend even to basic infrastructure needed for operation. The report recommends that donors and would-be donors should work with low-income health facilities to figure out what kind of surplus equipment the recipients could really use, and it also recommends more new medical devices that are neither expensive to make nor to operate.
7. BMJ – Open source
The UK, EU and US research agencies are progressively shifting their publication policy to ensure open access to publicly funded research. These changes are welcome and not only the taxpayers of those countries will benefit from it but citizens of the entire world. This article discusses whether we should go for open access journals or open access repositories.
8. South Africa To Become First PEPFAR Country To ‘Nationalize’ AIDS Program
The United States has spent $3.2 billion since 2004 on anti-AIDS programs in South Africa, and now South Africa will be the first PEPFAR country to nationalize an AIDS program. Other countries are also expected to follow.
9. Private Sector Becoming More Involved In Efforts To Reach Global Health Development Goals
This viewpoint argues that as GDP in LICs is increasing, the opportunities for the private sector to get active in previously not attractive niches are growing. There is an opportunity to develop innovative (their word) partnerships, there is no argument given on how and why this partnership would be beneficial. I particularly like the sentence “many of today’s market failure are tomorrow’s market opportunities”. The authors know how business works best: taking advantage of market failures.
10.Developing and Costing Local Strategies to Improve Maternal and Child Health: The Investment Case Framework
Jimenez Soto E, La Vincente S, Clark A, Firth S, Morgan A, et al.;
The authors report on how they have developed investment cases in four Asian countries, using the Soucat and Tanahashi models of bottleneck analysis, to help improve planning and budgeting for maternal neonatal and child health in disadvantaged health districts.
11.Science Speaks – Forty Percent Price Cut for Rapid TB Test Announced
Yesterday, the Office of the Global AIDS Coordinator (GAC), USAID, UNITAID and the Bill & Melinda Gates Foundation announced an agreement that will reduce the price of Xpert MTB/RIF cartridges from $16.86 to $9.98 with funds provided through this partnership.